Rotator Cuff Injury & Tear

The rotator cuff is a group of muscles and tendons that surrounds the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder.

A rotator cuff tear may result from an acute injury such as a fall or may be caused by chronic wear and tear with degeneration of the tendon. It can cause pain and disability with range of motion or use of the shoulder joint. If the tear occurs with injury you may experience acute pain, a snapping sensation, and immediate weakness of the arm.

Common symptoms of rotator cuff tear:

Pain at rest and at night

Pain when lifting and lowering your arm or with specific movements

Weakness when lifting or rotating your arm

Crackling sensation when moving your shoulder in certain positions

The severity of injury may range from a mild strain and inflammation of the muscle or tendon that will lead to no permanent damage to a partial or complete tear of the muscle that might require surgery for repair.

Most rotator cuff tears can be treated non-surgically. Dr Siow may prescribe anti-inflammatory medication, steroid injections, and physical therapy to treat the symptoms of a cuff tear. The goals these treatments are to relieve pain and restore strength to the involved shoulder.

However, if you still have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment, surgery may be necessary.

The type of repair performed is based on the findings. A partial tear may require only a trimming or smoothing procedure called a debridement, a full-thickness tear within the tendon can be repaired. If the tendon is torn from its insertion on the humerus, it is repaired directly to bone. It is recommended to seek Dr Siow’s professional treatment as he can advise which technique is best for you.

What is a Rotator Cuff Tear?

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade.

Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a network of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.

Types of Rotator Cuff Tear

When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved.

In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.

There are different types of tears.

Partial Tear. This type of tear damages the soft tissue, but does not completely sever it.

Full-Thickness Tear. This type of tear is also called a complete tear. It splits the soft tissue into two pieces. In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon.

Causes of Rotator Cuff Injuries

There are two main causes of rotator cuff tears: injury and degeneration.

Acute Tear

If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.

Degenerative Tear

Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder — even if you have no pain in that shoulder.

Several factors contribute to degenerative, or chronic, rotator cuff tears.

Repetitive stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well.

Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body’s natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.

Bone spurs. As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear.

Risk Factors

Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk.

People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters, and others who do overhead work also have a greater chance for tears.

Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.

Know Your Options

If you have a rotator cuff tear and you keep using it despite increasing pain, you may cause further damage. A rotator cuff tear can get larger over time.

Chronic shoulder and arm pain are good reasons to see your doctor. Early treatment can prevent your symptoms from getting worse. It will also get you back to your normal routine that much quicker.

The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for every person. In planning your treatment, your doctor will consider your age, activity level, general health, and the type of tear you have.

Nonsurgical Treatment

In about 50% of patients, nonsurgical treatment relieves pain and improves function in the shoulder. Shoulder strength, however, does not usually improve without surgery.

Nonsurgical treatment options may include:

Rest. Dr Siow may suggest rest and and limiting overhead activities. He may also prescribe a sling to help protect your shoulder and keep it still.

Strengthening exercises and physical therapy. Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.

Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine.

Surgical Treatment

We may recommend surgery if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery.

Other signs that surgery may be a good option for you includes :

Your symptoms have lasted 6 to 12 months

You have a large tear (more than 3 cm)

You have significant weakness and loss of function in your shoulder

Your tear was caused by a recent, acute injury

Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). There are a few options for repairing rotator cuff tears. Dr Siow will discuss with you the best procedure to meet your individual health needs.

Preparing for Surgery

If you decide to have a rotator cuff repair, you will need a complete physical examination with our doctor to assess your health and identify any problems that could interfere with your surgery.

Before surgery, tell your orthopaedic surgeon about any medications or supplements that you take. He or she will tell you which medicines you must stop taking before surgery (e.g. blood thinners).

You may be required to undergo pre-operative tests such as complete blood counts or an ECG (electrocardiogram).

Surgery

Most rotator cuff repair surgery is done on an day surgery basis.

Arrival
Your hospital or surgery center will contact you with specific details about your appointment. You will likely be asked to arrive at the hospital an hour or two before your surgery. Do not eat or drink anything after midnight the night before your surgery.

Anesthesia
When you first arrive for surgery, a member of the anesthesia team will talk with you to explain the anesthesia process with you.

Procedure
The orthopaedic surgeon will make a few small incisions in your shoulder. A sterile solution will be used to fill the shoulder joint and rinse away any cloudy fluid. This helps your orthopaedic surgeon see your shoulder clearly and in great detail.

The surgeon will insert the arthroscope and use the image projected on the screen to guide it. Your surgeon will insert small instruments through another small incision to treat the necessary areas.

This part of the procedure usually lasts 40 minutes to over an hour. How long it takes depends upon the findings and the treatment necessary.

Recovery

Postoperative

After surgery, you will stay in the recovery room for 1 to 2 hours before being discharged home. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night.

At Home

Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take weeks for your shoulder joint to completely recover.

You can expect some pain and discomfort for at least a week after surgery. If you have had a more extensive surgery, however, it may take several weeks before your pain subsides. Ice will help relieve pain and swelling. Your doctor may prescribe pain medicine, if needed.

Although it does not affect how your shoulder heals, lying flat may pull on your shoulder and cause discomfort. Some patients are more comfortable sleeping in a reclining chair or propped up in bed during the first days after surgery.

A few days after surgery, you should be able to replace your large bandage with simple Band-Aids. You may shower once your wounds are no longer draining, but try not to soak or scrub your incisions.

You will most likely need a sling or special immobilizer to protect your shoulder. Your surgeon will discuss with you how long the sling will be needed.

Rehabilitation

Rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain shoulder strength and motion.

Immobilization

After surgery, therapy progresses in stages. At first, the repair needs to be protected while the tendon heals. To keep your arm from moving, you will most likely use a sling and avoid using your arm for the first 4 to 6 weeks. How long you require a sling depends upon the severity of your injury.

Passive Exercise

Even though your tear has been repaired, the muscles around your arm remain weak. Once your surgeon decides it is safe for you to move your arm and shoulder, a therapist will help you with passive exercises to improve range of motion in your shoulder. With passive exercise, your therapist supports your arm and moves it in different positions. In most cases, passive exercise is begun within the first 4 to 6 weeks after surgery.

Active Exercise

After 4 to 6 weeks, you will progress to doing active exercises without the help of your therapist. Moving your muscles on your own will gradually increase your strength and improve your arm control. At 8 to 12 weeks, your therapist will start you on a strengthening exercise program.

Expect a complete recovery to take several months. Most patients have a functional range of motion and adequate strength by 4 to 6 months after surgery. Although it is a slow process, your commitment to rehabilitation is key to a successful outcome.